Pancreatic Cancer

Treatment Overview

Even if treatment doesn't usually cure the cancer, it may help you live longer and feel better. The most common treatments include surgery, radiation, and chemotherapy. Targeted therapy may also be used. Often a combination of these treatments is used.

Surgery

Surgery will be done to remove the tumor if possible. But most of the time the cancer has already spread so far that not all of it can be removed.

If surgery can remove all of the cancer, it can help you live longer. But even with successful surgery, the cancer often comes back.

If you are told that your cancer has spread too much for surgery, you may want to get a second opinion from a pancreatic cancer surgeon.

Surgery for pancreatic cancer includes:

• Whipple procedure. This is the most common surgery for pancreatic cancer. The surgeon may remove part of the pancreas, part of the stomach, part of the small intestine, and the gallbladder and common bile duct.
• Distal pancreatectomy. The surgeon may remove part of the pancreas and the spleen.
• Total pancreatectomy. The surgeon may remove the whole pancreas, part of the stomach, part of the small intestine, the bile duct, gallbladder, spleen and nearby lymph nodes.

You'll be in the hospital for 1 to 2 weeks after the surgery. You will probably be able to return to work or your normal routine in about 1 month. It will probably take about 3 months until your strength is back to normal. You will probably need more treatment for the cancer, such as chemotherapy or radiation.

Depending on how much of your pancreas is removed, you may need to take enzyme supplements (to replace the enzymes the pancreas makes) and anti-ulcer pills from now on. If your entire pancreas is removed, you will need to replace the insulin produced by your pancreas. You may have to check your blood sugar levels and take insulin.

Chemotherapy

Chemotherapy, sometimes called chemo, uses medicine to destroy cancer cells. The drugs used in this treatment can also affect healthy cells and cause side effects. Some of the common chemo drugs used for pancreatic cancer are:

• Gemcitabine.
• Fluorouracil (5-FU).
• (Nab)-paclitaxel.

Common side effects of these drugs include:

• Nausea, vomiting, and diarrhea.
• Loss of appetite.
• Hair loss.
• Mouth sores.
• Low blood counts, which may increase the risk of infection and bleeding.

Radiation

Radiation treatment may be used for certain types of pancreatic tumors.

External radiation is the kind of radiation most often used. It may be used along with chemotherapy. It may also be used before or after surgery.

Radiation can have side effects. The most common ones include:

• Extreme tiredness.
• Hair loss near the treated area.
• Skin darkening in the area.
• Loss of appetite.
• Nausea, vomiting, and diarrhea.
• Pain or a feeling of fullness in the belly.

Radiation can also be used to help control pain by shrinking the tumor so that it doesn't press on nerves or other organs.

Targeted therapy

Targeted therapy with tyrosine kinase inhibitors (TKIs), such as erlotinib, may be used. This medicine is taken by mouth. Targeted therapy can slow the growth of cancer cells.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

If you're interested in palliative care, talk to your doctor.

For more information, see the topic Palliative Care.

Pain control

Pain is one of the main concerns of people with pancreatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain.

• Nerve blocks are injections of alcohol or another liquid into the area of pain. The liquid numbs the nerves, interrupting the pain signal being sent to your brain. In some cases, the nerves carrying the pain sensation can actually be cut.
• Sometimes radiation or chemotherapy can be used to help ease the pain by shrinking the tumor.
• And there are stronger medicines your doctor can give you to help your pain.

Cancer: Controlling Cancer Pain

Removing a blockage

Sometimes the tumor presses on and blocks the bile duct where it passes through the pancreas. This can cause digestion problems. There are two ways to fix the blockage and help you feel better.

• Widen the blocked area so that it can drain. This may be done using an endoscope-a long, flexible tube that is inserted through your mouth all the way to the pancreas while you are sedated. Or it may be done by inserting a tube through your skin into the blocked area.
• Divert the flow of bile so that it goes around, instead of through, the pancreas. This requires surgery.

Because the pancreas is next to the stomach, the tumor can sometimes block the flow of food from the stomach to the first part of the small intestine. In that case, your doctor may do a gastric bypass, sewing the stomach directly to a lower part of the small intestine to get around the blocked area.

Clinical trials

Your doctor may talk to you about being in a clinical trial. For some people with pancreatic cancer, taking part in a clinical trial may be the best treatment choice.

Among the treatments being looked at by clinical trials for pancreatic cancer is biologic therapy, a treatment that uses your immune system to fight cancer.

End-of-life care

For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

For more information, see the topics:

• Hospice Care.
• Care at the End of Life.

Additional information about pancreatic cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/pancreatic.

Complementary treatment

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

• Acupuncture to relieve pain.
• Meditation or yoga to relieve stress.
• Massage or biofeedback to reduce pain and ease tension.
• Breathing exercises for relaxation.

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They aren't meant to take the place of standard medical treatment.